PLAN 03 : Core + Preventive +
Complete Care
Plan 03 is built from three parts that stack. Core Care carries the big events, Preventive Care takes care of wellness visits and screenings, and Complete Care includes services like labs and prescriptions at no cost at all.
Core Care
For major medical expenses
Surgical Care
& E.R.
Visits
Care
- Medical cost sharing with no overall annual or lifetime cap
- Member Responsibility Amount (MRA) Reduction Program
- Includes sharing for accidents, cancer, heart attacks, maternity, and more
Preventive Care
For wellness visits, screenings, and specialists
Screenings
Visits
Visits
Visits
Visits
Immunizations
Colonoscopies
& Functional Visits
- 2, 4 or 6 wellness visits per year based on membership tier
- Child wellness visits and immunizations
- Screenings: mammograms, colonoscopies, Cologuard
- Wellness specialist visits include: dermatology, vision, cardiology, OBGYN
- Holistic and alternative clinicians
Complete Care
$0 virtual care, labs, and prescription drugs
Urgent Care
Sick Visits
Health
Testing
Care
Management
Management
Drugs
- $0 virtual primary & urgent care, includes sick visits
- $0 virtual counseling, psychiatry, and crisis support
- 1,200+ $0 labs & tests
- 2,100+ $0 prescription drugsView prescription drug list →
Choose Your Member
Responsibility Amount (MRA)
The MRA is what you pay toward a single eligible event. Unlike a "deductible," it is not a yearly total you chip away at. Each Sharing Request carries its own — capped at two per household in any rolling 12 months.
You choose:
Higher monthly contribution Lower monthly contribution
More out of pocket ▶
Your MRA is what you pay. The community shares the rest.
The Member Responsibility Amount is what you pay toward one eligible medical event before the health share community shares the rest. You choose $1,500, $3,000, or $6,000 when you enroll. The higher the MRA, the lower your monthly contribution.
A Sharing Request applies to one member and one incident. The MRA attaches to that request, not to your calendar year. A broken arm in March and gallbladder surgery in September are two separate events, and each carries its own MRA.
Because the MRA belongs to the event rather than the year, there is no running balance to track and no reset date to race. Two unrelated needs never merge into one total, and an event that closes in December has no bearing on one that opens in January. Once an event's MRA is met, eligible bills for that event are shared at 100% with no overall annual or lifetime cap.
If nothing happens, you never pay an MRA at all. There is no annual amount to satisfy and nothing lost by not reaching it.
Related medical expenses must reach your MRA within six months of the first date of service. The Sharing Request then stays open for the full medical event — but a six-month gap in related treatment closes it, and any later care starts a new Sharing Request with a new MRA.
You may change your MRA once per membership year, with a 60-day wait when lowering it, except for accidents.
A hard stop at two MRAs,
per year, per household
Each household is responsible for no more than two MRAs in a rolling 12-month period. After that, additional eligible events over $1,000 are shared with no MRA at all. It’s how we help you control medical costs!
In the example below, the household chose a $1,500 MRA. The rolling 12 month period runs from March 2027 to March 2028 — it’s not a calendar year, Jan–Dec. Because the second Sharing Request came in June 2027, any further eligible events over $1,000 through March 2028 require no MRA.
First Sharing Request
Dad, skiing accident
Eligible bills above your MRA are shared at 100%.
Second Sharing Request
Mom, torn rotator cuff
Unrelated to the first, so it carries its own MRA. That is two.
Third Sharing Request
Son, rock climbing accident
The health share shares in additional eligible requests exceeding $1,000, with no further MRA.
Medical Costs Shared in Full
once your MRA is met
Eligible bills are shared in full after the Member Responsibility Amount, on a sharing request basis.
- Hospitalization, in-patient
- Emergency room for a medical emergency
- Outpatient ambulatory surgery center
- Doctor & specialist visits
- Advanced imaging — MRI, CT, MRA, PET
- Radiology
- Chemotherapy & radiation
- Oncology services
- Ambulance, emergency use
- Labor & delivery
Any provider · SharedCore Care has no network. See any doctor, hospital, or specialist you choose, present as a self-pay patient, and submit a Sharing Request. These bills are shared by the community once your MRA is met.
Using your membership
There is no network. Present as a self-pay patient at any provider you choose. The member is billed directly. Our member support team can also help you locate a provider if needed.
Your MRA may be reduced when you help keep costs down for the community — securing prepayment discounts, using fair-cost providers, traveling to a lower-cost facility, applying for self-pay assistance, or cooperating in provider negotiations. Reductions are discretionary and decided case by case.
Non-emergent surgery must be reviewed and approved before care to be eligible for sharing. Tell the Member Success Team as soon as surgery is recommended — they confirm eligibility, help obtain good-faith estimates, negotiate pricing, identify fair-cost providers, and facilitate prepayment. Expert second opinions are eligible for sharing. Emergency procedures need no prior review.
Members present as self-pay patients and can receive a debit card by email to pay for services directly, or request a reimbursement after the fact.
Prescriptions related to the treatment of an approved Sharing Request are shared for up to 12 months or $125,000 per Sharing Request, whichever occurs first.
Services with a set sharing allowance
Most eligible care is shared at 100%. These specific services carry a maximum the community will share after your MRA is met.
◆ Once per membership lifetime. All other allowances apply per Sharing Request.
Recovery therapies — from a new injury or illness as an active member
$3,500 allowance- Physical therapy
- Occupational therapy
- Speech therapy
- Chiropractic
- Acupuncture
- Craniosacral therapy
- Hyperbaric chamber
- Massage therapy
- Ozone therapy
- Dry needling
- Prolotherapy
- Infusion therapy
Only one recovery allowance applies per Sharing Request.
Maternity Care
Conception occurring within the first 30 days of membership is not eligible. A pregnancy existing before membership is not eligible. Open the Maternity Sharing Request within 30 days of pregnancy confirmation.
- Routine visits
- Ultrasounds
- Midwives
- Doula supplies & services
- Vitamins
- Acupuncture
- Chiropractic care
- Pelvic floor services
- Breast pumps
- Counseling
- Postpartum care
- Routine lab work
- STD & STI screenings
- Gestational diabetes care & medications
- Lactation consultant
- Six-week postpartum visit
- Two-week cesarean follow-up
No sharing limits apply to medically necessary delivery services, including labor and delivery, cesarean, premature and multiple births, anesthesiology, home birth, maternal complications, maternal-fetal specialist consultations, and one in-hospital pediatric evaluation with routine newborn testing.
Sharing is available for up to 35 days.
$125,000 sharing allowance.
A six-month supply of disposable diapers after delivery.
Add your newborn to the household membership within 30 days of birth. If the newborn is not enrolled within 30 days, any condition present at birth is treated as pre-existing.
Scenario
Understanding
Pre-Existing Conditions
A pre-existing limitation is applied based on the first date of active membership. A condition counts as pre-existing if, within the 12 months before membership, a person was examined, took medication, underwent monitoring, received treatment, or experienced recurring, persistent, or progressive symptoms — even without a formal diagnosis or medical evaluation.
Each amount is the most shared for that condition during that membership year, across all of its Sharing Requests. Unrelated pre-existing conditions each follow their own schedule.
Treated as pre-existing — phase-in applies
Phase-in- Arthritis, including degenerative disc disease
- Allergy treatment & reversal (non-seasonal)
- Cataracts
- Chronic fatigue
- Chronic pain
- Diagnostic colonoscopy
- Ear tubes
- Gastroesophageal reflux disease
- Injections & regenerative procedures from non-acute injury
- Joint replacement (not if acute injury)
- Osteoporosis
- Preventive mastectomy
- Surgical repairs & revisions
- Tonsil & adenoid removal (not if life-threatening)
- Varicose veins
What phases in is treatment of the condition itself. Ongoing management of it never does — see below.
Not treated as pre-existing
ExceptionHigh blood pressure, high cholesterol, hyperthyroidism, hypothyroidism, and type 2 diabetes are exceptions. Each is treated as not pre-existing if the condition is controlled and the member has not been hospitalized for it in the 12 months before enrollment.
What is not shareable
Never eligible under the phase-in schedule
Not eligible- Cancer diagnosed, treated, under evaluation, referred to oncology, or symptomatic within 36 months prior to membership
- Organ failure, end-stage organ disease, renal failure requiring dialysis, or ongoing renal replacement therapy
- Advanced systemic or degenerative conditions involving irreversible organ damage, active major organ failure, or dependence on life-sustaining therapy
There is no sharing in the maintenance of a chronic or pre-existing condition, and routine care intended to monitor, manage, or maintain one is not eligible at any time, in any membership year. On Plan 03, however, ongoing management of certain chronic conditions is included through Complete Care’s virtual care services. Contact Member Support for details.
Never eligible for sharing
Not eligible- Abortion
- Adult immunizations
- Alcohol or drug abuse treatment
- Birth control
- Breast implant removal
- Cosmetic surgery
- Diabetic medications & supplies
- Elective procedures
- Elective sterilization
- Genetic screening for risk assessment
- GLP-1 & semaglutides, including complications
- Hearing aids
- Infertility treatment
- IVF & fertility treatments
- Light therapies
- Mental health, non-emergent
- Organ donation expenses
- Prophylactic medications
- Routine dental
- Seasonal allergies
- Sleep studies
- Surrogacy
- TMJ therapeutics (non-surgical)
- Non-emergency transportation to medical appointments
- Vision hardware
Some of these may qualify under a Preventive Sharing Request if they are specifically included in your preventive benefits — see Preventive Care.
First 60 days of membership
Waiting periodNot eligible if signs, symptoms, diagnosis, or treatment occur within the first 60 days of membership:
- Gallbladder-related care
- Kidney stones
- Kidney disease
- Cancer diagnosis or staging
- Tumors, benign or malignant
Preventive care,
from day one
You never pay an MRA for preventive care, there is no waiting period, and it is never limited by a pre-existing condition. Each service is shared up to the allowance shown.
$250 allowance per appointment. Two, four, or six visits per household each membership year, set by tier — Tier 1 member only, Tier 2 member plus child(ren) or spouse, Tier 3 member plus spouse plus child(ren).
- Primary care
- Dermatology
- Cardiology
- Vision
- OBGYN
- $2,500 — Colonoscopy, from age 50, once every 5 years
- $681 — Cologuard, from age 40, once every 3 years
- $400 — Mammography or thermography, per membership year
Children up to age 5. $250 allowance per appointment.
Up to age 18, with an allowance based on CDC published pricing.
Any provider · SharedPreventive care has no network either. Any licensed clinician qualifies, including holistic and functional practitioners.
Two ways to pay
Reimbursement
For most routine visits and procedures. Pay as a self-pay patient, then open a preventive Sharing Request and send the itemized bill and your payment receipt.
Instant debit card
For more complex or expensive visits and procedures. Request a debit card by email and pay in advance or at the time of service. Asking for self-pay pricing and providing a good faith estimate keeps things moving.
Complete Care at
your fingertips
Six key services, every one at no cost, with no MRA and no waiting period. Complete Care comes only with Plan 03.
Virtual primary & urgent care
- 24/7 access to concierge-level care
- Wellness & sick visits
- Care coordination
- Quick appointment scheduling
- Lab & imaging referrals
Service partner · IncludedDelivered virtually by a Summit service partner. This is included with your membership rather than shared by the community, so there is no MRA and no Sharing Request — but care must be received through the partner.
Mental health
Call or message with a mental health concern on demand and be assessed promptly. Urgent or complex cases escalate to a psychiatric nurse practitioner or counselor. Includes stabilization, medication management, coaching, crisis support, and ongoing follow-up, with no fixed number of visits. Once stable, members step down to periodic check-ins, in-app screening, and peer support, and can re-engage whenever symptoms recur.
Service partner · IncludedProvided by a Summit service partner. Complex behavioral care and in-person treatment are not included; members who need either are referred to community providers at their own cost, while the virtual team continues coordination and support.
Chronic disease management
Ongoing virtual management of certain chronic conditions — monitoring, medication management, and regular follow-up with the care team.
Service partner · IncludedProvided by a Summit service partner. Not every chronic condition can be managed virtually — contact Member Support to confirm yours. Worth knowing: routine maintenance of a chronic or pre-existing condition is never eligible for sharing under Core Care. This is how Plan 03 addresses it instead.
Complete Care, continued
Weight & GLP-1 management
Medical consults, personalized treatment plans, ongoing coaching, lifestyle support, medication management where appropriate, and regular follow-up with the primary care team.
Service partner · IncludedThe management program is included through a Summit service partner. GLP-1 medications themselves are not shared or included, though the support team can assist in sourcing them through partner pharmacies, often at a discount.
Labwork & testing
Over 1,200 labs at no cost, with no MRA to meet first.
Service partner · IncludedThe $0 lab menu must be run through Summit’s designated lab partner, with 2,000+ locations nationwide. Labs run elsewhere are not included at $0.
Prescription drugs
Over 2,000 acute and chronic medications, all generic, available at no cost — including thyroid, blood pressure, cholesterol, diabetes, asthma, allergy, acid reflux, antibiotic, and mental health prescriptions.
Service partner · IncludedFilled through the partner pharmacy group — 70,000+ pharmacies nationwide, including mail order.
Summit Healthshare is a health share community network that connects its members to a broad range of healthcare services. Participants voluntarily share one another's medical expenses, adhering to community-established guidelines. Unlike conventional insurance, Summit is not categorized or regulated as an insurance or medical services provider. Members are not legally obliged to assist with another member's medical costs. This sheet is a summary; the Member Guidelines govern community sharing.
